HEALTH

HEALTH; For Group Doctors, a Winning Model

By CHRISTOPHER WEST DAVIS

Published: February 1, 2004

MOUNT KISCO—
WHILE the business problems of hospitals like Westchester Medical Center are acute and well known, some private practice doctor groups are doing just fine.

Take the Mount Kisco Medical Group, for example. It started with five doctors in 1942, and now has 87 doctors, double the number it had six years ago, in offices here and in Yorktown Heights and Carmel. Offering virtually every specialty in modern medicine, from rheumatology and neurology to sports medicine and plastic surgery, the group is the dominant provider in the northern part of the county, with all-in-one convenience for what group officials say is a roster of 200,000 patients, pulled from 60 miles in every direction.

The problems of the health-care industry are well known: reimbursement rates for virtually every service are fixed, managed care and health insurance are complicated, and government reimbursements for the poor and the elderly under Medicaid and Medicare are slim. As a result, it seems, doctors are forced to take more and more of a business role, at which Mount Kisco Medical Group has apparently excelled.

''Medicine has changed, unfortunately, for everyone in the country,'' said Dr. Scott D. Hayworth, chief executive officer of the Mount Kisco Medical Group, ''a medical group is really a business.''

The equation seems to be pretty clear. The group has expanded and taken over or merged with doctors in other practices, or has recruited specialists one by one. Almost all specialties are represented, so patients feel they can do one-stop shopping. The group has developed especially lucrative procedures like outpatient ambulatory surgery, taking a substantial chunk of that business away from local hospitals.

Most of Westchester's 2,500 private practice doctors work in groups of one to five, according to Stuart A. Hayman, executive director of the Westchester County Medical Society. Because of its affluence, ''Westchester is really a bastion for small groups, reminiscent of the old days,'' he said. Success with ''the big model,'' like Mount Kisco's, he said, is ''unusual for this county.''

Acknowledged as pioneers by the medical community, the group has still come in for criticism. Doctors outside the group worry, in general, that large group practices risk becoming businesses that feed on themselves, supplying incentives for in-house referrals and de-emphasizing outside second opinions and spending time with patients.

Dr. Daniel F. Peters, a solo-practice surgeon in the area, said there were too many trade-offs to joining a large group. ''Every decision is my own,'' he said. ''Nobody's over my shoulder saying, 'Come on, there are patients waiting out there.''' An independent affiliate of Mount Sinai Hospital, the Mount Kisco Medical Group, according to Dr. Hayworth, is ''the oldest multispecialty group in New York State.'' Last spring the group moved into all 60,000 square feet of T.W.A.'s old corporate headquarters on Bedford Road, in a purchase and remodeling aided by Mount Sinai. Patients are pulled from ''Manhattan, New Jersey, tip of Long Island and up north,'' he said. The group is held privately, and Dr. Hayworth declined to make the group's revenue or cost figures public. He said that of the 87 doctors, 63 were shareholders and that new doctors had to practice two years before being voted a piece of the pie.

The advantages of running a large group private practice range from the obvious to the subtle. Hospitals must deal with acute care, inpatients, the poor and unions, and they have to keep their doors open 24 hours a day, 7 days a week. ''Whether or not there's a CAT scan being performed at 2 in the morning, the CAT scanner is operational at that hour and is staffed,'' said Dr. Michael Finkelstein, who, up until this year, was the medical director of Northern Westchester Hospital, which sits across the street from Mount Kisco Medical Group. ''A private practice can close at 3 in the afternoon.''

Private practices can also turn away nonpaying patients. Hospitals cannot. Mount Kisco Medical's Web site, www.mkmg.com, lists: ''Traditional health insurance, managed care plans, Medicare. . .and patients who pay out of their own pockets.'' Absent from the list is Medicaid; like many other Westchester private doctors, the group doesn't take Medicaid.

''Medicaid is a very poor payer,'' Dr. Hayworth said. ''We don't take new Medicaid patients. As a community service, we see the Medicaid patients we already had, but we don't take any new ones.

''We are still providers of Medicare,'' he said. ''However, we are very troubled by the recent events in Washington. Medicare may have another cut in reimbursement. That will hurt senior access throughout the country. We feel an obligation to our patients, but there comes a point where people can't afford to provide the care that they feel comfortable providing. If the reimbursements drop under a certain level, doctors are going to have to make a tough decision.''

Another big group is the 70-strong Westchester Medical Group, based in White Plains, with seven offices in Mamaroneck, Rye and Purchase. Most of the doctors have an academic affiliation with Cornell-New York Presbyterian. Its president is Dr. Simeon A. Schwartz, who also pointed to Medicare reimbursements as an issue for his practice. Medicare reimbursement rates in 2005 will be the same as they were in 2001, while malpractice insurance has risen about 20 percent, according to Dr. Schwartz.